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CVS CAREMARK FORMULARY SUMMARY

ABILIFY Preferred Brand ACANYA Preferred Brand ACARBOSE Generic ACCU-CHEK Preferred Brand ACCU-CHEK AVIVA PLUS Preferred Brand ACCU-CHEK COMPACT Preferred Brand ACCU-CHEK FASTCLIX Preferred Brand ACCU-CHEK NANO SMARTVIEW Preferred Brand ACCU-CHEK SMARTVIEW Preferred Brand ACCU-CHEK SOFTCLIX Preferred Brand ACETAMINOPHEN-CODEINE Generic ACETIC ACID-ALUMINUM Generic ACTONEL Preferred Brand ACTOS Non-Preferred Brand ACYCLOVIR Generic ADAPALENE Generic ADVAIR DISKUS Preferred Brand ADVAIR HFA Preferred Brand ADVICOR Non-Preferred Brand AEROSPAN Non-Preferred Brand AGGRENOX Preferred Brand ALBUTEROL SULFATE Generic ALCLOMETASONE DIPROPIONATE Generic ALENDRONATE SODIUM Generic HCL ER Generic ALLOPURINOL Generic ALORA Non-Preferred Brand ALPHAGAN P Preferred Brand ALPRAZOLAM Generic ALPRAZOLAM ER Generic ALPRAZOLAM XR Generic ALREX Preferred Brand ALTAVERA Generic ALTOPREV Non-Preferred Brand ALVESCO Non-Preferred Brand ALYACEN Generic AMCINONIDE Generic AMETHIA Generic AMETHIA LO Generic -HYDROCHLOROTHIAZI Generic AMIODARONE HCL Generic AMITIZA Preferred Brand HCL Generic AMLODIPINE BESYLATE Generic AMLODIPINE BESYLATE-BENAZEP Generic AMLODIPINE-ATORVASTATIN Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

AMMONIUM LACTATE Generic AMNESTEEM Generic AMOX TR-POTASSIUM CLAVULANA Generic AMOXICILLIN Generic AMOXICILLIN-CLAVULANATE ER Generic AMPHETAMINE SALT COMBO Generic AMTURNIDE Preferred Brand ANASTROZOLE Generic ANDRODERM Preferred Brand ANDROGEL Non-Preferred Brand ANGELIQ Non-Preferred Brand ANORO ELLIPTA Preferred Brand ANTARA Non-Preferred Brand ANTIPYRINE-BENZOCAINE Generic ANUCORT-HC Generic APIDRA Preferred Brand APRI Generic APRISO Preferred Brand ARCAPTA Preferred Brand ARMOUR THYROID Non-Preferred Brand ARTHROTEC Non-Preferred Brand ASACOL HD Non-Preferred Brand ASCENSIA STRIPS AND KITS Non-Preferred Brand ASMANEX Preferred Brand ASTEPRO Preferred Brand ATACAND Non-Preferred Brand ATACAND HCT Non-Preferred Brand ATELVIA Preferred Brand Generic ATORVASTATIN CALCIUM Generic ATOVAQUONE-PROGUANIL HCL Generic ATRALIN Preferred Brand ATROVENT HFA Non-Preferred Brand AUVI-Q Preferred Brand AVIANE Generic AVODART Preferred Brand AVONEX Preferred Brand AXERT Non-Preferred Brand AXIRON Preferred Brand AZELASTINE HCL Generic AZELEX Non-Preferred Brand AZILECT Preferred Brand AZITHROMYCIN Generic AZOPT Preferred Brand AZOR Preferred Brand BACLOFEN Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

BD ULTRA-FINE PEN NEEDLE Preferred Brand BECONASE AQ Non-Preferred Brand BELLADONNA-PHENOBARBITAL Generic BENAZEPRIL HCL Generic BENAZEPRIL-HYDROCHLOROTHIAZ Generic BENICAR Preferred Brand BENICAR HCT Preferred Brand BENZAC AC Non-Preferred Brand BENZAC W Non-Preferred Brand BENZACLIN Preferred Brand BENZIQ Non-Preferred Brand BENZONATATE Generic BENZTROPINE MESYLATE Generic BESIVANCE Preferred Brand BETAMETHASONE DIPROPIONATE Generic BETAMETHASONE VALERATE Generic BETIMOL Preferred Brand BETOPTIC S Preferred Brand BEYAZ Preferred Brand BISOPROLOL FUMARATE Generic BISOPROLOL-HYDROCHLOROTHIAZ Generic BOSULIF Preferred Brand BREEZE 2 STRIPS AND KITS Non-Preferred Brand BREO ELLIPTA Non-Preferred Brand BRIELLYN Generic BRILINTA Preferred Brand TARTRATE Generic BUDESONIDE Generic BUPRENORPHINE HCL Generic BUPROPION HCL Generic BUPROPION HCL SR Generic BUPROPION XL Generic HCL Generic BUTALBITAL-ACETAMINOPHEN-CA Generic BUTRANS Preferred Brand BYDUREON Preferred Brand BYSTOLIC Preferred Brand CALCIPOTRIENE Generic CALCITRIOL Generic CAMRESE Generic CANASA Preferred Brand CARAC Preferred Brand CARBAMAZEPINE XR Generic CARBIDOPA-LEVODOPA Generic CARBIDOPA-LEVODOPA ER Generic CARDURA XL Non-Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

CARISOPRODOL Generic CARTIA XT Generic Generic CEFADROXIL Generic CEFDINIR Generic CEFPODOXIME PROXETIL Generic CEFPROZIL Generic CEFUROXIME Generic CELEBREX Preferred Brand CENESTIN Non-Preferred Brand CEPHALEXIN Generic CETIRIZINE HCL Generic CETROTIDE Preferred Brand CHERATUSSIN AC Generic CHLORDIAZEPOXIDE-CLIDINIUM Generic CHLORHEXIDINE GLUCONATE Generic CHLORTHALIDONE Generic CHOLESTYRAMINE Generic CHORIONIC GONADOTROPIN Generic CIALIS Preferred Brand CICLOPIROX Generic CIMZIA Non-Preferred Brand CIPROFLOXACIN HCL Generic CITALOPRAM HBR Generic CITRANATAL 90 DHA Preferred Brand CLARAVIS Generic CLARITHROMYCIN Generic CLARITHROMYCIN ER Generic CLIMARA Generic CLINDAGEL Non-Preferred Brand CLINDAMYCIN HCL Generic CLINDAMYCIN PALMITATE HCL Generic CLINDAMYCIN PHOS-BENZOYL PE Generic CLINDAMYCIN PHOSPHATE Generic CLINDAMYCIN-BENZOYL PEROXID Generic CLINPRO 5000 Generic CLOBETASOL PROPIONATE Generic CLOBEX SPRAY Preferred Brand CLODERM Preferred Brand CLONAZEPAM Generic HCL Generic CLOPIDOGREL Generic CLOTRIMAZOLE Generic CLOTRIMAZOLE-BETAMETHASONE Generic COLCRYS Preferred Brand COLESTIPOL HCL Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

COMBIGAN Preferred Brand COMBIVENT RESPIMAT Preferred Brand CONSTULOSE Generic CONTOUR NEXT STRIPS AND KITS Non-Preferred Brand COPAXONE Preferred Brand COREG CR Preferred Brand CORTIFOAM Preferred Brand COSOPT PF Preferred Brand CREON Preferred Brand CRESTOR Preferred Brand CRINONE Preferred Brand CRYSELLE Generic CYANOCOBALAMIN INJECTION Generic CYCLAFEM Generic HCL Generic CYCLOPENTOLATE HCL Generic CYCLOSPORINE Generic CYCLOSPORINE MODIFIED Generic CYMBALTA Preferred Brand HCL Generic DAYSEE Generic DAYTRANA Preferred Brand DELZICOL Non-Preferred Brand DENTA 5000 PLUS Generic DESLORATADINE Generic DESMOPRESSIN ACETATE Generic DESONIDE Generic DESOXIMETASONE Generic DETROL LA Non-Preferred Brand DEXAMETHASONE Generic DEXCOM G4 Preferred Brand DEXILANT Preferred Brand DEXMETHYLPHENIDATE HCL Generic DEXMETHYLPHENIDATE HCL ER Generic DEXTROAMPHETAMINE SULFATE E Generic DEXTROAMPHETAMINE-AMPHETAMI Generic DIAZEPAM Generic DICLEGIS Preferred Brand DICLOFENAC SODIUM Generic DICLOXACILLIN SODIUM Generic DICYCLOMINE HCL Generic DIFFERIN Preferred Brand DIFICID Preferred Brand DIFLORASONE DIACETATE Generic DIGOX Generic DIGOXIN Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

DILTIAZEM 24HR CD Generic DILTIAZEM 24HR ER Generic DILTIAZEM ER Generic DILTIAZEM HCL Generic DILT-XR Generic DIOVAN Preferred Brand DIOVAN HCT Non-Preferred Brand DIPHENOXYLATE-ATROPINE Generic DIVALPROEX SODIUM Generic DIVALPROEX SODIUM ER Generic DIVIGEL Preferred Brand DONEPEZIL HCL Generic DORAL Non-Preferred Brand DORZOLAMIDE- Generic MESYLATE Generic DOXYCYCLINE HYCLATE Generic DOXYCYCLINE MONOHYDRATE Generic DRONABINOL Generic DROSPIRENONE-ETHINYL ESTRAD Generic DUAVEE Preferred Brand DUEXIS Non-Preferred Brand DULERA Preferred Brand DULOXETINE HCL Generic DUREZOL Preferred Brand DYMISTA Non-Preferred Brand ECONAZOLE NITRATE Generic EDARBI Non-Preferred Brand EDARBYCLOR Non-Preferred Brand EDLUAR Non-Preferred Brand EFFIENT Preferred Brand ELIDEL Preferred Brand ELIQUIS Preferred Brand EMOQUETTE Generic ENABLEX Non-Preferred Brand ENALAPRIL MALEATE Generic ENBREL Preferred Brand ENJUVIA Non-Preferred Brand ENOXAPARIN SODIUM Generic ENPRESSE Generic ENSKYCE Generic EPIDUO Preferred Brand EPINEPHRINE Generic EPIPEN 2-PAK Preferred Brand EPIPEN JR 2-PAK Preferred Brand EPISIL Preferred Brand ERRIN Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

ERYTHROMYCIN Generic ESCITALOPRAM OXALATE Generic ESTRACE Preferred Brand ESTRADIOL Generic ESTRASORB Non-Preferred Brand ESTRING Non-Preferred Brand ESZOPICLONE Generic ETODOLAC Generic EUFLEXXA Non-Preferred Brand EVAMIST Preferred Brand EXALGO Preferred Brand EXELON PATCH Preferred Brand EXEMESTANE Generic EXFORGE Preferred Brand EXFORGE HCT Preferred Brand EXTAVIA Preferred Brand EXTROGEL Non-Preferred Brand FAMCICLOVIR Generic FAMOTIDINE Generic FARXIGA Non-Preferred Brand FELBAMATE Generic FELODIPINE ER Generic FEMRING Non-Preferred Brand FENOFIBRATE Generic FENOFIBRIC ACID Generic FENOGLIDE Non-Preferred Brand FENTORA Preferred Brand FERROUS SULFATE Generic FETZIMA Non-Preferred Brand FINACEA Preferred Brand FINASTERIDE Generic FIRST-TESTOSTERONE MC Non-Preferred Brand FLECTOR Non-Preferred Brand FLOVENT DISKUS Preferred Brand FLOVENT HFA Preferred Brand FLUCONAZOLE Generic FLUOCINOLONE ACETONIDE Generic FLUOCINOLONE ACETONIDE OIL Generic FLUOCINONIDE Generic FLUORIDE Generic FLUOROMETHOLONE Generic FLUOROURACIL Generic FLUOXETINE HCL Generic FLURBIPROFEN Non-Preferred Brand FLUTICASONE PROPIONATE Generic FLUVASTATIN SODIUM Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

FOLIC ACID Generic FOLLISTIM AQ Preferred Brand FONDAPARINUX SODIUM Generic FORADIL Preferred Brand FORTAMET Non-Preferred Brand FORTEO Preferred Brand FORTESTA Preferred Brand FOSAMAX PLUS D Non-Preferred Brand FOSINOPRIL SODIUM Generic FOSRENOL Non-Preferred Brand FREESTYLE LANCETS Non-Preferred Brand FREESTYLE LITE METER Non-Preferred Brand FREESTYLE LITE STRIPS Non-Preferred Brand FREESTYLE TEST STRIPS Non-Preferred Brand FROVA Non-Preferred Brand FUROSEMIDE Generic GABAPENTIN Generic GATIFLOXACIN Generic GAVILYTE-N Generic GELNIQUE Preferred Brand GEL-ONE Preferred Brand GENOTROPIN Non-Preferred Brand GENTAK Generic GENTAMICIN SULFATE Generic GIANVI Generic GILDESS Generic GILDESS FE Generic GILENYA Preferred Brand GLEEVEC Preferred Brand GLIMEPIRIDE Generic GLIPIZIDE Generic GLIPIZIDE ER Generic GLIPIZIDE XL Generic GLIPIZIDE- Generic GLUMETZA Non-Preferred Brand GLYBURIDE Generic GLYCOPYRROLATE Generic GRALISE Preferred Brand GUAIATUSSIN AC Generic GUAIFENESIN AC Generic GUAIFENESIN-CODEINE Generic HCL Generic HALOBETASOL PROPIONATE Generic HEATHER Generic HUMALOG Non-Preferred Brand HUMALOG MIX 50-50 Non-Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

HUMALOG MIX 75-25 Non-Preferred Brand HUMATROPE Preferred Brand HUMIRA Preferred Brand HUMULIN Non-Preferred Brand HYALGAN Preferred Brand HYDRALAZINE HCL Generic Generic HYDROCODONE BIT-IBUPROFEN Generic HYDROCODONE-ACETAMINOPHEN Generic HYDROCODONE-CHLORPHENIRAMIN Generic HYDROCODONE-HOMATROPINE MBR Generic HYDROCORTISONE Generic HYDROCORTISONE ACETATE Generic HYDROCORTISONE VALERATE Generic HYDROCORTISONE-ACETIC ACID Generic HYDROCORTISONE-PRAMOXINE Generic HYDROMORPHONE HCL Generic HYDROXYCHLOROQUINE SULFATE Generic HCL Generic HYDROXYZINE PAMOATE Generic HYOSCYAMINE SULFATE Generic HYPERCARE Generic IBANDRONATE SODIUM Generic IBUPROFEN Generic HCL Generic IMIQUIMOD Generic INCIVEK Preferred Brand INDAPAMIDE Generic INDOMETHACIN Generic INNOPRAN XL Non-Preferred Brand INTERMEZZO Non-Preferred Brand INTROVALE Generic INTUNIV Preferred Brand INVOKANA Preferred Brand IOPHEN-C NR Generic IPRATROPIUM BROMIDE Generic IPRATROPIUM-ALBUTEROL Generic IRBESARTAN Generic IRBESARTAN-HYDROCHLOROTHIAZ Generic ISONIAZID Generic ISOSORBIDE MONONITRATE ER Generic ISTALOL Non-Preferred Brand JALYN Non-Preferred Brand JANTOVEN Generic JANUMET Preferred Brand JANUMET XR Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

JANUVIA Preferred Brand JENTADUETO Preferred Brand JOLIVETTE Generic JUNEL Generic JUNEL FE Generic KARIVA Generic KAZANO Non-Preferred Brand KELNOR 1-35 Generic KETAMINE HYDROCHLORIDE Non-Preferred Brand KETOCONAZOLE Generic KETOPROFEN Generic KETOROLAC TROMETHAMINE Generic KLOR-CON 10 Generic KLOR-CON M10 Generic KLOR-CON M20 Generic KOMBIGLYZE XR Non-Preferred Brand HCL Generic LACTULOSE Generic LAMICTAL ODT Preferred Brand LAMOTRIGINE Generic LAMOTRIGINE ER Generic LANSOPRAZOLE Generic LANTUS Preferred Brand LASTACAFT Non-Preferred Brand LATANOPROST Generic LATUDA Preferred Brand LAZANDA Preferred Brand LESCOL XL Non-Preferred Brand LETAIRIS Preferred Brand LETROZOLE Generic LEUPROLIDE ACETATE Generic LEVALBUTEROL HCL Generic LEVEMIR Preferred Brand LEVEMIR FLEXPEN Preferred Brand LEVETIRACETAM Generic LEVOCETIRIZINE DIHYDROCHLOR Generic LEVOFLOXACIN Generic LEVONORGESTREL-ETH ESTRADIO Generic LEVONORG-ETH ESTRAD ETH EST Generic SODIUM Generic LEVOXYL Generic LEXAPRO Non-Preferred Brand LIALDA Preferred Brand LIDOCAINE Generic LIDOCAINE HCL VISCOUS Generic LIDOCAINE-PRILOCAINE Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

LINZESS Preferred Brand LIPITOR Non-Preferred Brand LIPTRUZET Non-Preferred Brand LISINOPRIL Generic LISINOPRIL-HYDROCHLOROTHIAZ Generic LIVALO Non-Preferred Brand LO LOESTRIN FE Preferred Brand LOCOID LIPOCREAM Preferred Brand LOCOID LOTION Preferred Brand LOPERAMIDE Generic LORAZEPAM Generic LORAZEPAM INTENSOL Generic LORYNA Generic LOSARTAN POTASSIUM Generic LOSARTAN-HYDROCHLOROTHIAZID Generic LOTEMAX Preferred Brand LOTRONEX Preferred Brand LOVASTATIN Generic LOVAZA Preferred Brand LUDENT FLUORIDE Generic LUMIGAN Non-Preferred Brand LUNESTA Non-Preferred Brand LYRICA Preferred Brand MARLISSA Generic MECLIZINE HCL Generic MEDROXYPROGESTERONE ACETATE Generic MEFLOQUINE HCL Generic MELOXICAM Generic MENEST Non-Preferred Brand MENOSTAR Non-Preferred Brand MENTAX Preferred Brand MERCAPTOPURINE Generic MESALAMINE Generic METAXALONE Generic METFORMIN HCL Generic METFORMIN HCL ER Generic METHIMAZOLE Generic METHOCARBAMOL Generic METHOTREXATE Generic METHYLPHENIDATE ER Generic METHYLPHENIDATE HCL Generic METHYLPHENIDATE HCL CD Generic METHYLPHENIDATE LA Generic METHYLPREDNISOLONE Generic METOCLOPRAMIDE HCL Generic SUCCINATE Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

METOPROLOL TARTRATE Generic METRONIDAZOLE Generic MICARDIS Preferred Brand MICROGESTIN Generic MICROGESTIN FE Generic MINASTRIN 24 FE Preferred Brand MINIVELLE Preferred Brand MINOCYCLINE HCL Generic MIRAPEX ER Preferred Brand Generic MISOPROSTOL Generic MODAFINIL Generic MOMETASONE FUROATE Generic MONTELUKAST SODIUM Generic MORPHINE SULFATE Generic MORPHINE SULFATE ER Generic MOVIPREP Preferred Brand MOXEZA Preferred Brand MUGARD Preferred Brand MULTIVITAMIN WITH FLUORIDE Generic MUPIROCIN Generic MYCOPHENOLATE MOFETIL Generic MYZILRA Generic NABUMETONE Generic Generic NAMENDA Preferred Brand NAMENDA XR Preferred Brand NAPRELAN Non-Preferred Brand NAPROXEN Generic NAPROXEN SODIUM Generic NARATRIPTAN HCL Generic NASONEX Preferred Brand NATAZIA Preferred Brand NECON Generic NEOMYCIN SULFATE Generic NEOMYCIN-POLYMYXIN-DEXAMETH Generic NEOMYCIN-POLYMYXIN-HC Generic NEOMYCIN-POLYMYXIN-HYDROCOR Generic NEORAL Preferred Brand NESINA Non-Preferred Brand NEUPRO Preferred Brand NEXIUM Preferred Brand NIACIN ER Generic NIFEDICAL XL Generic NIFEDIPINE ER Generic NITROFURANTOIN Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

NITROFURANTOIN MONO-MACRO Generic NITROGLYCERIN Generic NITROLINGUAL Preferred Brand NITROMIST Non-Preferred Brand NITROSTAT Preferred Brand NORDITROPIN Preferred Brand NORETHINDRONE Generic NORETHINDRONE ACETATE Generic NORGESTIMATE-ETHINYL ESTRAD Generic HCL Generic NOVOLIN 70-30 Preferred Brand NOVOLOG Preferred Brand NOVOLOG FLEXPEN Preferred Brand NOVOLOG MIX 70-30 FLEXPEN Preferred Brand NOXAFIL Non-Preferred Brand NUCYNTA Preferred Brand NUCYNTA ER Preferred Brand NUTROPIN AQ Non-Preferred Brand NUVARING Preferred Brand NYSTATIN Generic NYSTATIN-TRIAMCINOLONE Generic NYSTOP Generic OCELLA Generic OFLOXACIN Generic Generic OLUX-E Non-Preferred Brand OMEGA-3 ACID ETHYL ESTERS Generic OMEPRAZOLE Generic OMNARIS Non-Preferred Brand OMNITROPE Non-Preferred Brand ONDANSETRON HCL Generic ONDANSETRON ODT Generic ONE TOUCH DELICA Preferred Brand ONE TOUCH LANCETS Preferred Brand ONE TOUCH ULTRA 2 Preferred Brand ONE TOUCH ULTRA CONTROL SOL Preferred Brand ONE TOUCH ULTRA SYSTEM Preferred Brand ONE TOUCH ULTRA TEST STRIPS Preferred Brand ONE TOUCH VERIO Preferred Brand ONETOUCH FINEPOINT LANCETS Preferred Brand ONGLYZA Non-Preferred Brand OPANA ER Preferred Brand ORACEA Preferred Brand ORPHENADRINE CITRATE Generic ORSYTHIA Generic ORTHO TRI-CYCLEN LO Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

ORTHOVISC Non-Preferred Brand OSENI Non-Preferred Brand OSPHENA Preferred Brand OVIDREL Preferred Brand OXCARBAZEPINE Generic OXSORALEN-ULTRA Preferred Brand OXYBUTYNIN CHLORIDE ER Generic OXYCODONE HCL Generic OXYCODONE HCL-ACETAMINOPHEN Generic OXYCODONE-ACETAMINOPHEN Generic OXYCONTIN Preferred Brand OXYTROL Non-Preferred Brand PACERONE Generic PANCREAZE Non-Preferred Brand PANTOPRAZOLE SODIUM Generic PARICALCITOL Generic PAROXETINE HCL Generic PATADAY Preferred Brand PATANASE Preferred Brand PATANOL Preferred Brand PEG-3350 AND ELECTROLYTES Generic PEG-3350 WITH FLAVOR PACKS Generic PENICILLIN V POTASSIUM Generic PENNSAID Preferred Brand PENTASA Preferred Brand PENTOXIFYLLINE Generic PERFOROMIST Preferred Brand PERMETHRIN Generic PERTZYE Non-Preferred Brand PEXEVA Non-Preferred Brand PHENAZOPYRIDINE HCL Generic PHENOBARBITAL Generic PHOSLYRA Preferred Brand PICATO Preferred Brand PIOGLITAZONE HCL Generic PIROXICAM Generic PLAVIX Non-Preferred Brand POLYETHYLENE GLYCOL 3350 Generic POLYMYXIN B SUL-TRIMETHOPRI Generic POTASSIUM CHLORIDE Generic PRADAXA Preferred Brand PRAMIPEXOLE DIHYDROCHLORIDE Generic PRAVASTATIN SODIUM Generic HCL Generic PRECISION XTRA STRIPS AND KITS Non-Preferred Brand PRED MILD Non-Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

PREDNISOLONE Generic PREDNISOLONE ACETATE Generic PREDNISOLONE SODIUM PHOSPHA Generic PREDNISONE Generic PREFERAOB Non-Preferred Brand PREFEST Non-Preferred Brand PREMARIN Preferred Brand PREMARIN CREAM Preferred Brand PREMPHASE Preferred Brand PREMPRO Preferred Brand PRENAPLUS Generic PRENATABS RX Generic PRENATAL PLUS Non-Preferred Brand PREVACID Non-Preferred Brand PREVIFEM Generic PRISTIQ ER Preferred Brand PROAIR HFA Preferred Brand MALEATE Generic PROCTOCREAM-HC Generic PROCTOSOL-HC Generic PROCTOZONE-HC Generic PROGESTERONE Generic PROGESTERONE IN OIL Generic HCL Generic PROMETHAZINE-CODEINE Generic PROPAFENONE HCL Generic HCL Generic PROPRANOLOL HCL ER Generic PROTONIX Non-Preferred Brand PROTOPIC Preferred Brand PROVENTIL HFA Preferred Brand PULMICORT FLEXHALER Preferred Brand QNASL Non-Preferred Brand QSYMIA Preferred Brand QUASENSE Generic FUMARATE Generic QUILLIVANT XR Preferred Brand QUINAPRIL HCL Generic QUININE SULFATE Generic QVAR Preferred Brand RABEPRAZOLE SODIUM Generic RAMIPRIL Generic RANITIDINE HCL Generic RAPAFLO Preferred Brand RAYOS Non-Preferred Brand RELENZA Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

RELION INSULIN Non-Preferred Brand RELPAX Preferred Brand RENAL CAPS Generic RENVELA Preferred Brand RESTASIS Preferred Brand RETIN-A MICRO Preferred Brand RHINOCORT AQUA Non-Preferred Brand RIOMET Non-Preferred Brand Generic RIZATRIPTAN Generic ROXICET Generic ROZEREM Non-Preferred Brand Non-Preferred Brand SANCUSO Preferred Brand SAVELLA Preferred Brand SE 10-5 SS Generic SELENIUM SULFIDE Generic SEREVENT Preferred Brand SEROQUEL XR Preferred Brand SERTRALINE HCL Generic SEVELAMER CARBONATE Generic SF 5000 PLUS Generic SILVER SULFADIAZINE Generic SIMBRINZA Preferred Brand SIMCOR Preferred Brand SIMVASTATIN Generic SINGULAIR Non-Preferred Brand SKELID Non-Preferred Brand SODIUM CHLORIDE Generic SODIUM FLUORIDE Generic SORILUX Preferred Brand Generic SOVALDI Preferred Brand SPIRIVA Preferred Brand SPIRONOLACTONE Generic SPRINTEC Generic SPRYCEL Preferred Brand SRONYX Generic STRATTERA Preferred Brand STRIANT Non-Preferred Brand SUBOXONE FILM Non-Preferred Brand SUCLEAR Preferred Brand SUCRALFATE Generic SULFACETAMIDE SODIUM Generic SULFAMETHOXAZOLE-TRIMETHOPR Generic SUMATRIPTAN SUCCINATE Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

SUMAVEL DOSEPRO Preferred Brand SUPARTZ Preferred Brand SUPRAX Preferred Brand SUPREP Preferred Brand SURE-TEST STRIPS AND KITS Non-Preferred Brand SYMBICORT Preferred Brand SYNTHROID Preferred Brand SYNVISC Non-Preferred Brand SYNVISC-ONE Non-Preferred Brand TAMIFLU Preferred Brand HCL Generic TANZEUM Non-Preferred Brand TAZORAC Preferred Brand TECFIDERA Preferred Brand TEKAMLO Preferred Brand TEKTURNA Preferred Brand TEKTURNA HCT Preferred Brand TEMAZEPAM Generic HCL Generic TERBINAFINE HCL Generic TERCONAZOLE Generic TESTIM Non-Preferred Brand TESTOSTERONE CYPIONATE Generic TESTOSTERONE ENANTHATE Generic TEVETEN Non-Preferred Brand TEVETEN HCT Non-Preferred Brand TEV-TROPIN Non-Preferred Brand TIMOLOL MALEATE Generic HCL Generic TOBRADEX OINTMENT Preferred Brand TOBRADEX ST Preferred Brand TOBRAMYCIN Generic TOBRAMYCIN-DEXAMETHASONE Generic TOLTERODINE TARTRATE ER Generic TOPIRAMATE Generic TORSEMIDE Generic TOVIAZ Non-Preferred Brand TRACLEER Preferred Brand TRADJENTA Preferred Brand TRAMADOL HCL Generic TRAMADOL HCL ER Generic TRAMADOL HCL-ACETAMINOPHEN Generic TRAVATAN Z Preferred Brand HCL Generic TRETINOIN Generic TRETINOIN MICROSPHERE Generic This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

TREXIMET Preferred Brand TRIAMCINOLONE ACETONIDE Generic TRIAMTERENE-HCTZ Generic TRIAMTERENE-HYDROCHLOROTHIA Generic TRIBENZOR Preferred Brand TRICOR Non-Preferred Brand TRIFLURIDINE Generic TRIGLIDE Non-Preferred Brand TRI-LEGEST FE Generic TRILIPIX Non-Preferred Brand TRIMETHOBENZAMIDE HCL Generic TRINESSA Generic TRIPHROCAPS Generic TRI-PREVIFEM Generic TRI-SPRINTEC Generic TRI-VITAMIN WITH FLUORIDE Generic TRUETEST STRIPS AND KITS Non-Preferred Brand TRUETRACT STRIPS AND KITS Non-Preferred Brand TUDORZA PRESSAIR Non-Preferred Brand ULORIC Preferred Brand ULTRESA Preferred Brand URSODIOL Generic VAGIFEM Preferred Brand VALACYCLOVIR Generic VALSARTAN Generic VALSARTAN-HYDROCHLOROTHIAZI Generic VALTREX Non-Preferred Brand VANCOMYCIN HCL Generic VANOS Non-Preferred Brand VASCEPA Non-Preferred Brand VELPHORO Preferred Brand VENLAFAXINE HCL Generic VENLAFAXINE HCL ER Generic VENTOLIN HFA Non-Preferred Brand VERAMYST Non-Preferred Brand VERAPAMIL ER Generic VERAPAMIL HCL Generic VESICARE Preferred Brand VIAGRA Preferred Brand VICODIN Generic VICODIN ES Generic VICODIN HP Generic VICTOZA 2-PAK Preferred Brand VICTOZA 3-PAK Preferred Brand VICTRELIS Preferred Brand VIGAMOX Preferred Brand This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan. CVS CAREMARK FORMULARY SUMMARY

VIIBRYD Preferred Brand VIMOVO Preferred Brand VIMPAT Preferred Brand VIOKACE Preferred Brand VIORELE Generic VIRTUSSIN AC Generic VITAFOL-ONE Non-Preferred Brand VITAMIN D2 Generic VIVELLE-DOT Preferred Brand VOGELXO Non-Preferred Brand VOLTAREN GEL Preferred Brand VYTORIN Preferred Brand VYVANSE Preferred Brand WARFARIN SODIUM Generic WELCHOL Preferred Brand WYMZYA FE Generic XARELTO Preferred Brand XOPENEX HFA Non-Preferred Brand ZELAPAR Preferred Brand ZENCHENT FE Generic ZENPEP Preferred Brand ZETIA Preferred Brand ZETONNA Non-Preferred Brand ZIOPTAN Preferred Brand ZOLMITRIPTAN Generic ZOLPIDEM TARTRATE Generic ZOLPIDEM TARTRATE ER Generic ZOMIG NASAL SPRAY Preferred Brand ZONISAMIDE Generic ZOVIA 1-35E Generic ZUBSOLV Preferred Brand ZYCLARA Preferred Brand ZYFLO Non-Preferred Brand ZYFLO CR Non-Preferred Brand ZYLET Preferred Brand

This is not a complete list of all prescription drugs. This list is intended for summary purposes only. Details of coverage are set forth in separate documents, which govern your prescription drug plan.